56.4 Amputating through the upper arm and elbow

Save as much of the length of the patient’s arm as you can, because he will probably have no prosthesis. If possible, disarticulate his elbow. If you amputate higher up, a convenient place is 18 to 20 cm below his acromion. If you can leave him with a reasonable length of humerus, he can use it to hold things by gripping them against his chest. If you have to amputate very high up, even a very short stump will preserve the outline of his shoulder. If he is to have a prosthesis, don’t amputate through the lower 4 cm of his humerus, because it will be difficult to fit.

Remember that his brachial artery lies quite superficially, and is overlapped medially by his biceps.